With all the emphasis on having more conversation about mental health, remarkably little attention has been paid to how exactly we want to be having it. In what follows, we review five areas about which sharp differences currently exist: (1) Biology – how are physiological contributors to mental distress being framed? (2) Symptoms – how should we best work with distressing signs in the body? (3) Action Steps – what needs to happen in order to improve mental health in the nation? (4) Barriers – what are the primary barriers that need to be overcome in improving public mental health? (5) Lifestyle – what role do lifestyle choices play in mental health? After illustrating the different positions being taken on each of these questions, we then consider the diverging implications for individuals and families facing these problems. We conclude with recommendations as to how the larger dialogue on mental health could become more inclusive and productive.